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CFPC exam KM > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Where is McBurney’s point

A

1/3 from anterior superior iliac spine to umbilicus

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2
Q

What is Rovsing’s sign

A

Palpation of left abdomen causes pain at McBurney’s point
Can be a sign on inferior appendix

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3
Q

What is psoas sign

A

Pain on flexion of hip against resistance or passive hyperextension of hip
Can be a sign of retrocecal appendix

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4
Q

What is obturator sign

A

Flexion then external or internal rotation of right hip hip causes pain
Can be a sign of a pelvic appendix

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5
Q

Investigations for appendicitis

A

Increased WBC
R/o pregnancy
AXR - free air if peroratoed, loss of psoas shadow
US - rule out gyne causes, may be able to visualise appendix
CT - thick wall, appemdocloth, only done after us considered

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6
Q

Management of appendicitis

A

IVF
Surgery
Abx - ampicillin, gentamicin and metronidazole

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7
Q

What is the definition of cholecystitis

A

inflamed gallbladder 2ndary to impacted gallstone

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8
Q

What is the definition of choledocholithiasis

A

gallstone in common bile duct

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9
Q

What is the definition of cholangitis

A

Obstructed of common bile duct causing biliary sepsis

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10
Q

What is charcot’s triad

A

fever, RUQ pain and jaundice

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11
Q

What is Reynold’s pentad

A

fever, RUQ pain, jaundice, shock, confusion

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12
Q

Investigations for cholecystitis/cholangitis

A

Increases WCC
Increased bili, ALT, ASST, *ALP
Blood cultures
R/o pancreatitis
Ultasound

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13
Q

Management of cholecystitis/cholangitis

A

NPO, IVF
NG if ileum
Analgesia
Abx - ampicillin + gentamicin/cipro + met
cholecystitis - surgery
cholangitis - ERCP + sphincterotomy, consider laparotomy

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14
Q

Signs of symptoms of diverticulitis

A

Fever
LLQ pain
Alternating constipation and diarrhea
Urinary symptoms
Nausea/vomiting
S+S fistula
Fever

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15
Q

Investigations for diverticulitis

A

Leukocytosis, increased Cr
Urinalysis, CRP
AXR - free air
**CT

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16
Q

Management for diverticulitis

A

Outpatient/uncomplicated:
Bowel rest/ clear liquid diet x 2-3 days
High fibre diet
Cipro and falgyl or amoxicillin/clav if indicated

Complicated:
NPO, IVF, NG
Cipro and flagyl
Percutaneous drainage if abscess
C scope after 6-8 weeks

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17
Q

When to consider surgery in diverticulitis

A

Unstable with peritonitis
Abscess >/ 4 cm / fistula / ruptured abscess
Complex

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18
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Tumours

Scorpion sting
Mmicrobiology - TB, mumps reubella, HIV, CMV
Autoimmune
Surgery/trauma
Hyperlipidemia
Emboli/ischaemia
Drugs (furosemidem estrogen, H2 blockers, valproate, abx, ASA)

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19
Q

Signs and symptoms of pancreatitis

A

Pain, epigastric, radiates to pain, decreased leaning forward
N and V
Jaundice
Hypotension / tachycardia
Cullens and grey turners sign

20
Q

Investigations for pancreatitis

A

High WBC
High amylase
High lipase - preferred test
High ALT
AXR - colon cut off sign
Ultrasound - preferred test
CT

21
Q

Management of pancreatitis

A

IVF
NPO, NG
Analgesia
Drain abscess
Surgery if necrotic

22
Q

What is Ranson’s criteria

A

Prognosis for pancreatitis

At admission:
Glucose >11
Age >55
LDH >350
AST >250
WBC >16

During 48h:
Ca <2
HCG decreased more than 10%
aPO2 <60
Base >4
Urea increase > 1.8

23
Q

What gene is celiac related to

A

HLA-DQ2/DQ8

24
Q

What are the patterns of celiac disease

A

Classic: malabsorption symptoms
Non-classic: intestinal and extraintestinal symptoms
Subclinical: no symptoms, diagnosed from screening
Potential: abnormal antibiotics but normal histology

25
Q

What conditions are associated with celiac disease

A

T1DM
Autoimmune thyroditis and liver disease
Down syndrome
Turner syndrome
IgA deficienc

26
Q

What rash is typically seen in celiac

A

dermatitis herpetiform

27
Q

What deficiencies are commonly seen in celiac disease

A

Vitamin B12 deficiency
Iron deficiency
Can have low calcium and vitamin D

28
Q

What investigations are done to investigate for celiac disease

A

** Anti-TTG IgA
Must have equivalent of 3 slices of wheat bread a day for 1-3 months prior to testing
Serum IgA - if deficient order Anti-DGP

29
Q

What monitoring should be done for celiac disease?

A

Annual anti-TTG
Q2Year TSH
Q1Year if previously normal ALT and AST

30
Q

What cancer is associated with celiac

A

High risk T-cell lymphoma

30
Q

What are the dermatological extraintestinal manifestations of crohn’s

A

Erythema nodosum
Pyoderma gangrenous
Perianal skin tags
Oral mucosal lesions
Psoriasis
Pallor

31
Q

What are the rheumatological extraintestinal manifestations of crohn’s

A

Inflammatory arthropathy
AnkSpon
Sacroilitis

32
Q

What are the occular extraintestinal manifestations of crohn’s

A

Uveitis
Episcleritis

33
Q

What are the hepatobiliary extraintestinal manifestations of crohn’s

A

Primary sclerosing chalngitis
Fatty liver

34
Q

What are the urological extraintestinal manifestations of crohn’s

A

Stones
Fistula

35
Q

What is the sequelae of malabsoprtion in Crohn’s?

A

Anemia
Cholelithiasis
Nephrolithiasis
Metabolic bome disease

36
Q

What are the immune mediated diseases associated with Crohn’s

A

Asthma
Chronic bronchitis
Pericarditis
Psoriasis
Celiac
RA
MS

37
Q

What medications are used for an acute flare of Crohn’s

A

Prednisone

38
Q

What medications are used in Crohn’s

A

Thiopuriness
Methotrexate
Biologics

39
Q

What are the risks of long term PPI use

A

Hip fracture
C Diff
Pneumonia
Low vitamin b12, mag, iron
Hypoparathyroid

40
Q

What are the Rome IV criteria

A

Recurrent abdo pain on ave atleast 1 day a week for the past 3 months with 2 of the following:
Related to defecation
Associated with a change in freq of stool
Assocaited with a change in appearance of stool

41
Q

What is the treatment for H. Pylori

A

First line:
Amoxicillin 1000mg BID + Clarithromycin 500mg BID + Metronidazole 500mg BID and PPI for 14 days

If penicillin allergic:
Bismuth + tetracycline + metronidazole + PPI

42
Q

What is always involved in UC

A

the rectum

43
Q

What is the montreal classification of UC

A

Proctitis - within 18cm of anal verge distal to rectosigmoid junction

Left sided colitis - extending from sigmoid to splenic flexure

Right sided colitis - beyond the splenic flexure

44
Q

What are the treatments for UC

A

5ASA
MMX
Biologics

45
Q

Crohns vs UC

A

CFPC exam KM (16 decks)

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